Provider Demographics
NPI:1093134579
Name:FISHER, MICHELLE ANGELA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELA
Last Name:FISHER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ALPINE AVE, SUITE 385,
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-440-2456
Mailing Address - Fax:303-440-2427
Practice Address - Street 1:1155 ALPINE AVE STE 385
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3422
Practice Address - Country:US
Practice Address - Phone:303-440-2456
Practice Address - Fax:303-440-2427
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO113546363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health